Provider Demographics
NPI:1467820928
Name:HERRERA-VERDUGO, OCTAVIO
Entity Type:Individual
Prefix:
First Name:OCTAVIO
Middle Name:
Last Name:HERRERA-VERDUGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 WAINWRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1900
Mailing Address - Country:US
Mailing Address - Phone:847-593-8460
Mailing Address - Fax:224-235-4652
Practice Address - Street 1:1225 BRECKENRIDGE DR STE 110
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1565
Practice Address - Country:US
Practice Address - Phone:501-391-1741
Practice Address - Fax:501-421-3802
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3534207RC0000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease